HL7 Australia has taken a significant step forward in its quest to change its governance structure and institute constitutional reform, as it continues its growth march and positions itself as the leader in the nation’s moves towards healthcare interoperability.
As part of its “maturity journey”, the data exchange standards organisation has increased its membership, with large scale vendors including Cerner, Oracle, InterSystems, DXC and MuleSoft joining the community, while putting in place the framework to suit the scale up.
Originally incorporated as an entity in the ACT in 2002, HL7 Australia had been required to conduct at least 50 per cent of its trade inside the territory’s borders. Following legal advice in 2015, the organisation has undertaken a lengthy and consultative restructuring process to support its growth spurt.
It was a process designed to generate consensus and make the sweeping changes stick, HL7 Australia Chair Jason Steen told Healthcare IT News Australia.
“I realised that given the fact that we need 75 per cent of members to agree to change the constitution it’s not something that we could progress at speed, regardless of the urgency of the need for change,” he said
Seven months ago, a constitutional sub-committee was formed that HL7 members were invited to join, and principles around the new constitution were drafted.
“I was quite keen that it be transparent, that there be enough time for the membership to get involved and contribute, that every single person that wished to be a part of the constitutional subcommittee were.”
The changes were put to the vote and endorsed last November and a constitution drafted. But the final step was putting it to a vote at the general meeting on in April, where it received 89 votes for, six against and four absentions.
“That meant it got across the line,” Steen said.
[Read more: Australian FHIR innovation a frontrunner as the US government looks to standardise health data exchange | The titan enters the race: Apple to launch Health Records app with HL7's FHIR specifications at 12 hospitals]
Now positioned to change to an association limited by guarantee, the reforms represent HL7 Australia’s passage through essential growing pains towards a not-for-profit legal structure that suits its ambitions.
Included in the major changes:
- the increase from seven board members to eight
- four office bearing positions instead of three with the addition of the position of director of membership
- two office bearers and two ordinary board members will refresh each calendar year, with the others refreshing in the subsequent year to ensure continuity of the board
- a new tier one level of the membership that carries 12 votes and collects larger entities with multiple subsidiaries – such as Telstra – into a single bloc.
Steen said the changes represent progress for an organisation that is the custodian of the HL7 and FHIR standards in Australia.
HL7 Australia now has 15 benefactor members, including the Australia Digital Health Agency, Queensland Health and NSW Health.
With membership on the rise, the new arrangements will allow the community to thrive.
“We see our job as a board as feeding and watering the community, and the community itself comes up with the recommendations of changes to standards. The community itself prioritises which standards are more important at any given point in time and that can often be driven by actual programs of work out in the community, whether it be with a vendor or a jurisdiction or whomever,” he said.
“So we as a board don’t see ourselves as prioritising the standards that are going to be developed in FHIR and HL7 but supporting that process and also promoting the use of standards, of course.”
The stakes are high, according to Steen, with healthcare data sharing contingent on the technical standards brought about by a community of common purpose.
“Without a group way of communicating, interoperability is close to impossible.”
Within its efforts, HL7 Australia’s Argonaut project is localising the work of the US Argonaut project, with the involvement of the international project manager for FHIR Grahame Grieve and stakeholders such as Cerner.
“There is an opportunity here to progress the Australianisation of Argonaut in a way where it’s done once and done with complete input rather than on an installation-by-installation basis.”
With recent announcements that FHIR has been adopted as the interoperability standard for use by Apple’s Health Records, and the US Department of Health and Human Services looking towards the open source technology as its standard for health information exchange, this is an exciting time.
“There has been a desire in the community for a long period of time for this type of progress, so for many of us, is finally this is happening, because the solution here has not been unknown to the community but it’s the adoption that counts. The adoption of this approach more widely and particularly with US government direct support is very encouraging for us.”
As he prepared to fly to Germany to join the HL7 International Conference and Working Group Meeting, Steen said that aside from the Australian outfit’s governance structure, discussions will likely touch on the need for the governance of FHIR to mature as it progressively becomes the preferred global standard.
“That is a topic of the conversation at every international event!”
Steen said the international HL7 community needs to determine the most appropriate governance of FHIR to fuel innovation.
“It’s been an ongoing topic. The strength of FHIR has been its ability to rapidly develop and of course any governance structures that you change over the top of that to get more clinical input or whatever the aim would be, you'd wish not to stifle that.
“Also, the more parties that enter the conversation, the more careful you have to be about ensuring that the standard progresses at an appropriate speed.”
The influence of Australia in the global movement towards healthcare interoperability is one that is well-known and has been earned over many years of effort.
“It's recognised at the international community how influential Australia is in that community. There was a time, a number of years ago, when the Australian delegation was just massively larger than any others, so you might have five people from Germany and two from the UK and one person from the whole of South America and 45 people from Australia turned up.”
It is a long-held commitment that stands Australia in good stead as the digital health transition takes off.
“That has meant that the international standard itself over a number of decades has been shaped in a way that is compatible with the Australian health market. And with international vendors writing their products to conform with international standard, it then creates a smaller step for any localisations to be made that are proprietary to us, because most of what we need is already in the international standard.
“And it's a default position of our community: if a gap is seen in a standard to first argue for it to be dealt with in the international standard, because if it can be dealt with there then we know that globally software will align in a way that suits Australia.”